Provider Demographics
NPI:1811174766
Name:LEVINE, CRAIG LEE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:LEE
Last Name:LEVINE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 CASTRO ST
Mailing Address - Street 2:#643
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-2512
Mailing Address - Country:US
Mailing Address - Phone:415-845-5897
Mailing Address - Fax:
Practice Address - Street 1:830 MENLO AVE
Practice Address - Street 2:200
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4751
Practice Address - Country:US
Practice Address - Phone:415-845-5897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21757103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist